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    The workshop standardized the definition of meibomian gland dysfunction (MGD), which can be one component of eyelid inflammation, called blepharitis. Have I started a new job or moved into a new place? If patients can predict when symptoms will worsen, they can also be more aggressive with treatment, as needed, said Dr. And even though blepharitis is typically treated only when symptoms are present, asymptomatic blepharitis may also need to be addressed before ocular surgery, he added. (A) typical cylindrical dandruff at the root of the eyelashes (arrow); (B) misdirected lashes (arrow); (C) meibomian gland dysfunction (arrow); (D) lid margin inflammation (arrow); (E) bulbar conjunctiva inflammation; (F) corneal infiltration and pannus (arrow). Blepharitis, which often contributes to dry eye syndrome, can cause many ocular symptoms, including itching, grittiness, photophobia, eyelid crusting, and red, swollen eyes. ___________________________ Although the connection between Demodex mite infestation and blepharitis has been reported since at least the early 1960s, “When we eradicate or cut down infestations, we can see patients improve,” said Scheffer C. Tseng, MD, Ph D, medical director of the Ocular Surface Center in Miami. More than 8 in 10 people over age 60 are infested with mites, while others have no symptoms, said Dr. He drew an analogy to the house-dust mite—some people can live with it and never get sick, but others have asthma attacks. Beyond causing patient discomfort, the presence of blepharitis can affect the outcomes of cataract and refractive surgery. Did I switch cosmetics or just get my nails or hair done? In addition to precipitating hypersensitivity reactions, mites may cause direct damage, such as eyelash disorders, and may block meibomian glands. Perry first uses a slit lamp to check for cylindrical dandruff (Fig. If he finds it, he removes an eyelash and checks for mites under a microscope. On average, mites have a three-week lifespan, and hygiene is critical for interrupting their life cycle, said Dr. “Mites should die out if you don’t let them mate.” Unfortunately, eyelids are less accessible to thorough cleaning because they are surrounded by the nose, eyebrow, and cheekbone. With both antimicrobial and anti-inflammatory effects, tea tree oil has been effective at eradicating mites, said Dr. And, as the prevalence of blepharitis increases with age, clinicians can expect to see a growing number of cases in the coming years. “They may also be a vector for a species of bacillus that causes rosacea-like problems,” said Dr. infestation is much more commonly found in patients who don’t respond to other treatment,” said Dr. Tseng, in either 50 percent lid scrubs or 5 percent lid massages. How can ophthalmologists best manage this common, yet complex, condition? Nelson noted, because estrogen promotes inflammation. Because higher concentrations can be irritating, however, his team (with research supported by the National Eye Institute) worked to identify the active ingredient in tea tree oil for killing mites. Starting with how to assess symptoms to determine appropriate treatment, three experts outline their approaches—with an eye to the tried-and-true, as well as to newer techniques—that maybe prove helpful for some patients. They have developed a treatment containing this ingredient, which is better tolerated by patients. Tseng said, “This new lid scrub regimen, known as Cliradex, will be available this year.” ___________________________ 1 Post CF et al. A thorough ophthalmologic evaluation, along with a careful history, is critical for zeroing in on the best treatment approaches. Perry, MD, chief of the cornea service at Nassau University Medical Center in East Meadow, N. Daniel Nelson, MD, professor of ophthalmology at the University of Minnesota, in Minneapolis, involves patients in tracking clues to their condition. Patient self-care plays a major role in the management of blepharitis. Omega-3 fatty acids are known to be anti-inflammatory, said Dr. He starts some blepharitis patients on supplements of 1 to 3 g, two to three times daily. Oral Azithromycin for Treatment of Posterior Blepharitis Cornea Treating blepharitis in the pediatric population Page 3 of 4 Optometry. Azithromycin Better Than Doxy for MGD - Review of Optometry
     
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